Weight-loss surgery cuts risk of death among morbidly obese

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Extremely obese people who have weight-loss surgery are likely to live longer than those who don’t, even if the patients are older men with multiple health problems, a new study by Seattle’s Group Health researchers and others finds.

Overall, the risk of dying was cut by more than half — 53 percent — over 14 years in patients who had gastric bypass, gastric banding or other forms of bariatric surgery, according to an analysis of data from U.S. Veterans Affairs centers published Tuesday in the Journal of the American Medical Association.

It’s the latest proof that weight-loss surgery may not only reverse disease and improve quality of life, but also reduce mortality, even in a mostly male population with a mean age of 52 and a mean body mass index of 47 — in some cases, 140 pounds or more overweight.

“Most of the evidence to date really focuses on younger women with fewer health problems,” said Dr. David Arterburn, an associate investigator with the Group Health Research Institute and one of the study’s authors. “It’s exciting to learn that the findings we’ve found for women in the past are also present for men — and older men.”

Arterburn and his colleagues analyzed data for 2,500 Veterans Affairs patients who had bariatric surgery between 2000 and 2011 and matched them to nearly 7,500 controls who didn’t get the operations. At the end of the study period, which ran through December 2013, there were 263 deaths among the surgery patients and 1,277 deaths in the matched control group.

Adjusted analyses showed that that resulted in a 55 percent reduced risk of death one to five years after the operations and an overall 53 percent reduced risk from five to 14 years later.

About three-quarters of the patients in the study were male, and surgery patients were more likely than controls to suffer from common maladies of obesity, including high blood pressure, diabetes, gastric reflux disease and fatty liver disease.

The findings are evidence that it can take a long time, and a lot of patients, to confirm something as profound as a reduction in mortality, said Dr. Philip Schauer, a bariatric surgeon and director of the Bariatric and Metabolic Institute at the Cleveland Clinic. When an earlier version of the study was published in 2011, it did not show a clear survival benefit after the operations.

The new study is “very significant,” Schauer said.

“It’s extremely rare to have a surgical intervention that actually extends life span,” he added.

About 179,000 weight-loss surgeries were performed in the U.S. in 2013, according to the American Society for Metabolic and Bariatric Surgery. About 70 to 80 percent of patients who opt for the surgery are women, Arterburn and Schauer said.

“It’s societal pressures,” Schauer suggested. “It’s more socially acceptable for men to have a belly than women.” In addition, women are far more likely than men to seek medical care for problems.

But the new study should encourage more extremely obese men to ask their doctors about the surgery. A body mass index, or BMI, of 47 means a person who is 5-foot-6 would weigh 295 pounds, when normal weight is 155 pounds, Arterburn said.

A BMI of 30 is considered obese, but in the U.S., about 15 percent of adults have BMIs of 35, and more than 6 percent have BMIs of 40, according to federal health figures.

In the first year after surgery, the typical patient in the study lost 109 pounds, Arterburn added. And 58 percent of patients lost 30 percent or more of their body weight.

More research is needed to track potential long-term risks of weight-loss surgery, but in the meantime, it could be a potential option for the very heavy, Arterburn said.

“Bariatric surgery is not a population-based solution, but for people who have tried and failed, it is an option,” he said.